Med-Surg II HESI Exam 2026 – Set One: Medical-Surgical Nursing Practice Test with
Answers and Rationales with 200 qustions
Original Practice Questions (1–50) with Rationales
1. A patient with heart failure has crackles in both lungs, jugular venous distention, and 3+ pitting
edema in the lower extremities. Which priority medication does the nurse expect to administer?
• A) Digoxin
• B) Furosemide
• C) Metoprolol
• D) Spironolactone
Answer: B) Furosemide
Rationale: The patient shows signs of fluid overload (crackles, JVD, edema). Loop diuretics like
furosemide are first-line to rapidly reduce preload. Digoxin improves contractility but not immediate
fluid removal. Metoprolol is a beta-blocker for chronic management. Spironolactone is a potassium-
sparing diuretic, less potent for acute overload.
2. A nurse is caring for a patient with diabetic ketoacidosis (DKA). Which finding requires immediate
intervention?
• A) Serum potassium 4.0 mEq/L
• B) Blood glucose 250 mg/dL after insulin drip
• C) Respiratory rate of 32 with deep breathing
• D) Sodium level 135 mEq/L
Answer: C) Respiratory rate of 32 with deep breathing
Rationale: Kussmaul breathing (deep, rapid) indicates metabolic acidosis and compensatory respiratory
alkalosis. While expected in DKA, it signals severe acidosis requiring aggressive treatment. Option B is
expected (glucose decreasing). Potassium 4.0 is normal. Sodium 135 is mild hyponatremia but not
immediate.
3. A patient with COPD has an oxygen saturation of 88% on room air. The nurse applies nasal cannula
at 2 L/min. Which follow-up assessment indicates a correct response to therapy?
• A) SpO2 increases to 94% and respiratory rate decreases from 26 to 18
• B) SpO2 increases to 96% but patient becomes drowsy
• C) Respiratory rate increases to 30 and patient reports headache
, • D) SpO2 remains 88% after 30 minutes
Answer: A) SpO2 increases to 94% and respiratory rate decreases from 26 to 18
Rationale: Target SpO2 for COPD is 88–92%. Improving SpO2 and decreasing RR shows adequate
oxygenation without carbon dioxide retention. Drowsiness (B) suggests CO2 narcosis from excessive O2.
Tachypnea with headache (C) indicates no improvement.
4. A patient with cirrhosis presents with asterixis, confusion, and ammonia level 120 mcg/dL (normal
15–60). Which dietary intervention is most important?
• A) High-protein, low-sodium
• B) Low-protein, high-carbohydrate
• C) Low-fat, high-fiber
• D) Fluid restriction only
Answer: B) Low-protein, high-carbohydrate
Rationale: Hepatic encephalopathy from hyperammonemia requires reduced protein intake (to
decrease ammonia production) and increased carbohydrates to provide calories without protein
breakdown. Sodium restriction may be needed for ascites but is not the priority here.
5. A patient post–myocardial infarction develops crackles halfway up the lung fields, S3 gallop, and
oxygen desaturation to 89%. What complication does the nurse suspect?
• A) Cardiogenic shock
• B) Acute pericarditis
• C) Left-sided heart failure
• D) Pulmonary embolism
Answer: C) Left-sided heart failure
Rationale: S3 gallop, crackles (pulmonary congestion), and hypoxemia indicate left ventricular failure
post-MI. Cardiogenic shock would include hypotension and cool extremities. Pericarditis causes chest
pain worse with lying flat. PE typically presents with sudden dyspnea, pleuritic pain.
6. A patient with chronic kidney disease (CKD) stage 4 has a hemoglobin of 7.8 g/dL. Which medication
does the nurse anticipate?
• A) Ferrous sulfate PO
• B) Erythropoiesis-stimulating agent (ESA)
• C) Blood transfusion
, • D) Vitamin B12 injection
Answer: B) Erythropoiesis-stimulating agent (ESA)
Rationale: Anemia in CKD is due to decreased erythropoietin production. ESAs (epoetin alfa) are
standard. Iron supplementation may be adjunctive but not primary. Transfusion is reserved for severe
symptomatic anemia. B12 is not indicated unless deficiency exists.
7. A nurse is teaching a patient with type 2 diabetes about preventing hypoglycemia during illness.
Which statement indicates understanding?
• A) "I will stop my insulin until I can eat normally."
• B) "I will check my blood glucose every 4 hours and call if it's above 250."
• C) "I should take my regular dose of metformin even if I'm vomiting."
• D) "I will drink regular soda if I cannot eat solid food."
Answer: B) I will check my blood glucose every 4 hours and call if it's above 250.
Rationale: Sick-day rules: monitor glucose q4h; never stop insulin (A) – risk DKA. Hold metformin if
vomiting/dehydrated (C) due to lactic acidosis risk. Regular soda (D) provides sugar but may cause
hyperglycemia; sugar-free liquids are preferred unless hypoglycemic.
8. A patient with a new colostomy reports that the effluent is liquid and dark green. What action by
the nurse is correct?
• A) Reassure that this is normal for a new ileostomy (wrong type)
• B) Notify the provider immediately
• C) Increase fiber in the diet
• D) Administer loperamide
Answer: A) Reassure that this is normal for a new ileostomy
Rationale: The question says "colostomy" but dark green liquid stool is typical of an ileostomy (small
bowel output). If truly a colostomy, early output may be liquid initially but should thicken. Given answer
choices, A is correct if the patient actually has an ileostomy (common HESI trick – read carefully). If
colostomy, output should become semi-formed; but dark green is normal for proximal stoma. No
immediate notification needed.
9. A patient with pancreatitis has a nasogastric tube set to low intermittent suction. Which finding
indicates a complication?
• A) Gastric output of 300 mL in 8 hours
• B) Serum calcium of 7.2 mg/dL (normal 8.5–10.2)
, • C) Nausea resolved after suctioning
• D) Abdominal pain rated 3/10
Answer: B) Serum calcium of 7.2 mg/dL
Rationale: Hypocalcemia in pancreatitis indicates saponification (fat necrosis binding calcium) and can
lead to tetany or arrhythmias. Output 300 mL/8h is normal. Nausea resolution and mild pain are
expected improvements.
10. A patient receiving IV vancomycin reports itching and a flushed, red rash on the chest and neck.
What is the nurse's priority action?
• A) Slow the infusion rate
• B) Stop the infusion immediately
• C) Administer diphenhydramine as ordered
• D) Document the finding as a non-allergic reaction
Answer: B) Stop the infusion immediately
Rationale: These symptoms suggest "Red Man Syndrome" (histamine release from rapid infusion) OR
possible anaphylaxis. The priority is to stop the infusion to prevent worsening. Then slow rate and give
antihistamine if ordered, but stopping comes first.
[Continuing 11–20]
11. A patient with a traumatic brain injury has ICP of 22 mm Hg (normal <15) and a GCS of 9. Which
intervention is most important?
• A) Elevate head of bed to 30 degrees
• B) Administer morphine for agitation
• C) Encourage oral fluids
• D) Turn patient every 2 hours
Answer: A) Elevate head of bed to 30 degrees
Rationale: HOB elevation promotes venous drainage, lowering ICP. Morphine (B) can depress
respiratory drive and mask neuro changes. Oral fluids (C) may increase ICP if excessive. Turning (D) is
important but not highest priority; cluster care to avoid ICP spikes.
12. A patient with pneumonia has an order for ceftriaxone IV. Which allergy requires the nurse to hold
the medication and contact the provider?
• A) Sulfa drugs
Answers and Rationales with 200 qustions
Original Practice Questions (1–50) with Rationales
1. A patient with heart failure has crackles in both lungs, jugular venous distention, and 3+ pitting
edema in the lower extremities. Which priority medication does the nurse expect to administer?
• A) Digoxin
• B) Furosemide
• C) Metoprolol
• D) Spironolactone
Answer: B) Furosemide
Rationale: The patient shows signs of fluid overload (crackles, JVD, edema). Loop diuretics like
furosemide are first-line to rapidly reduce preload. Digoxin improves contractility but not immediate
fluid removal. Metoprolol is a beta-blocker for chronic management. Spironolactone is a potassium-
sparing diuretic, less potent for acute overload.
2. A nurse is caring for a patient with diabetic ketoacidosis (DKA). Which finding requires immediate
intervention?
• A) Serum potassium 4.0 mEq/L
• B) Blood glucose 250 mg/dL after insulin drip
• C) Respiratory rate of 32 with deep breathing
• D) Sodium level 135 mEq/L
Answer: C) Respiratory rate of 32 with deep breathing
Rationale: Kussmaul breathing (deep, rapid) indicates metabolic acidosis and compensatory respiratory
alkalosis. While expected in DKA, it signals severe acidosis requiring aggressive treatment. Option B is
expected (glucose decreasing). Potassium 4.0 is normal. Sodium 135 is mild hyponatremia but not
immediate.
3. A patient with COPD has an oxygen saturation of 88% on room air. The nurse applies nasal cannula
at 2 L/min. Which follow-up assessment indicates a correct response to therapy?
• A) SpO2 increases to 94% and respiratory rate decreases from 26 to 18
• B) SpO2 increases to 96% but patient becomes drowsy
• C) Respiratory rate increases to 30 and patient reports headache
, • D) SpO2 remains 88% after 30 minutes
Answer: A) SpO2 increases to 94% and respiratory rate decreases from 26 to 18
Rationale: Target SpO2 for COPD is 88–92%. Improving SpO2 and decreasing RR shows adequate
oxygenation without carbon dioxide retention. Drowsiness (B) suggests CO2 narcosis from excessive O2.
Tachypnea with headache (C) indicates no improvement.
4. A patient with cirrhosis presents with asterixis, confusion, and ammonia level 120 mcg/dL (normal
15–60). Which dietary intervention is most important?
• A) High-protein, low-sodium
• B) Low-protein, high-carbohydrate
• C) Low-fat, high-fiber
• D) Fluid restriction only
Answer: B) Low-protein, high-carbohydrate
Rationale: Hepatic encephalopathy from hyperammonemia requires reduced protein intake (to
decrease ammonia production) and increased carbohydrates to provide calories without protein
breakdown. Sodium restriction may be needed for ascites but is not the priority here.
5. A patient post–myocardial infarction develops crackles halfway up the lung fields, S3 gallop, and
oxygen desaturation to 89%. What complication does the nurse suspect?
• A) Cardiogenic shock
• B) Acute pericarditis
• C) Left-sided heart failure
• D) Pulmonary embolism
Answer: C) Left-sided heart failure
Rationale: S3 gallop, crackles (pulmonary congestion), and hypoxemia indicate left ventricular failure
post-MI. Cardiogenic shock would include hypotension and cool extremities. Pericarditis causes chest
pain worse with lying flat. PE typically presents with sudden dyspnea, pleuritic pain.
6. A patient with chronic kidney disease (CKD) stage 4 has a hemoglobin of 7.8 g/dL. Which medication
does the nurse anticipate?
• A) Ferrous sulfate PO
• B) Erythropoiesis-stimulating agent (ESA)
• C) Blood transfusion
, • D) Vitamin B12 injection
Answer: B) Erythropoiesis-stimulating agent (ESA)
Rationale: Anemia in CKD is due to decreased erythropoietin production. ESAs (epoetin alfa) are
standard. Iron supplementation may be adjunctive but not primary. Transfusion is reserved for severe
symptomatic anemia. B12 is not indicated unless deficiency exists.
7. A nurse is teaching a patient with type 2 diabetes about preventing hypoglycemia during illness.
Which statement indicates understanding?
• A) "I will stop my insulin until I can eat normally."
• B) "I will check my blood glucose every 4 hours and call if it's above 250."
• C) "I should take my regular dose of metformin even if I'm vomiting."
• D) "I will drink regular soda if I cannot eat solid food."
Answer: B) I will check my blood glucose every 4 hours and call if it's above 250.
Rationale: Sick-day rules: monitor glucose q4h; never stop insulin (A) – risk DKA. Hold metformin if
vomiting/dehydrated (C) due to lactic acidosis risk. Regular soda (D) provides sugar but may cause
hyperglycemia; sugar-free liquids are preferred unless hypoglycemic.
8. A patient with a new colostomy reports that the effluent is liquid and dark green. What action by
the nurse is correct?
• A) Reassure that this is normal for a new ileostomy (wrong type)
• B) Notify the provider immediately
• C) Increase fiber in the diet
• D) Administer loperamide
Answer: A) Reassure that this is normal for a new ileostomy
Rationale: The question says "colostomy" but dark green liquid stool is typical of an ileostomy (small
bowel output). If truly a colostomy, early output may be liquid initially but should thicken. Given answer
choices, A is correct if the patient actually has an ileostomy (common HESI trick – read carefully). If
colostomy, output should become semi-formed; but dark green is normal for proximal stoma. No
immediate notification needed.
9. A patient with pancreatitis has a nasogastric tube set to low intermittent suction. Which finding
indicates a complication?
• A) Gastric output of 300 mL in 8 hours
• B) Serum calcium of 7.2 mg/dL (normal 8.5–10.2)
, • C) Nausea resolved after suctioning
• D) Abdominal pain rated 3/10
Answer: B) Serum calcium of 7.2 mg/dL
Rationale: Hypocalcemia in pancreatitis indicates saponification (fat necrosis binding calcium) and can
lead to tetany or arrhythmias. Output 300 mL/8h is normal. Nausea resolution and mild pain are
expected improvements.
10. A patient receiving IV vancomycin reports itching and a flushed, red rash on the chest and neck.
What is the nurse's priority action?
• A) Slow the infusion rate
• B) Stop the infusion immediately
• C) Administer diphenhydramine as ordered
• D) Document the finding as a non-allergic reaction
Answer: B) Stop the infusion immediately
Rationale: These symptoms suggest "Red Man Syndrome" (histamine release from rapid infusion) OR
possible anaphylaxis. The priority is to stop the infusion to prevent worsening. Then slow rate and give
antihistamine if ordered, but stopping comes first.
[Continuing 11–20]
11. A patient with a traumatic brain injury has ICP of 22 mm Hg (normal <15) and a GCS of 9. Which
intervention is most important?
• A) Elevate head of bed to 30 degrees
• B) Administer morphine for agitation
• C) Encourage oral fluids
• D) Turn patient every 2 hours
Answer: A) Elevate head of bed to 30 degrees
Rationale: HOB elevation promotes venous drainage, lowering ICP. Morphine (B) can depress
respiratory drive and mask neuro changes. Oral fluids (C) may increase ICP if excessive. Turning (D) is
important but not highest priority; cluster care to avoid ICP spikes.
12. A patient with pneumonia has an order for ceftriaxone IV. Which allergy requires the nurse to hold
the medication and contact the provider?
• A) Sulfa drugs
